Provider Demographics
NPI:1093762403
Name:ECKARD, TIMOTHY FRANKLIN (MSPT, CERT MDT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:FRANKLIN
Last Name:ECKARD
Suffix:
Gender:M
Credentials:MSPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19627 SIDANI LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-1997
Mailing Address - Country:US
Mailing Address - Phone:661-513-0023
Mailing Address - Fax:661-513-0023
Practice Address - Street 1:25176 RYE CANYON RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:661-288-0300
Practice Address - Fax:661-288-0388
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 30318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT30318AMedicare UPIN
CAS70821Medicare UPIN